View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0761
ICR Reference No:
200812-0920-002
Status:
Historical Active
Previous ICR Reference No:
200708-0920-001
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Randomized Controlled Trial for Routine Screening for Intimate Partner Violence
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/22/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/10/2008
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2011
01/31/2011
01/31/2011
Responses
3,814
0
3,814
Time Burden (Hours)
718
0
718
Cost Burden (Dollars)
0
0
0
Abstract:
Intimate partner violence (IPV) occurs frequently and has serious health, economic, and social consequences. Given the seriousness of this problem, numerous professional and health care organizations have recommended routine screening of women for IPV by health care providers in primary care settings. We propose a randomized controlled trial that will recruit 3680 women in a public obsetrics, gynecology, and family planning clinic. Women attending this clinic tend to be African American and of lower socioeconomic status. For this study (the Main Study), women will be randomly allocated to one of three arms: 1) screened for IPV, and if disclosing IPV, provided information on available IPV services; 2) not screened and all receiving information on available IPV services; or 3) a control group that will not be screened nor receive information on available IPV services.
Authorizing Statute(s):
US Code:
42 USC 301
Name of Law: Public Health Service Act Research and Investigation General
US Code:
42 USC 391
Name of Law: Public Health Service Act Prevention and Control of Injuries
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
71 FR 42644
07/27/2006
30-day Notice:
Federal Register Citation:
Citation Date:
72 FR 38837
07/13/2007
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Eligibility Screening for Pretest and Main Study
None
Eligibility Script for Pretest and Main Study
Main Study Baseline
None, None
Baseline Questionnaire
,
Supplementary Quality of Life Questions
Main Study Followup
None, None
Main Study Follow-up Questionnaire
,
Supplementary Quality of Life Questions
Pretest Baseline
None, None
Supplementary Quality of Life Questions
,
Pretest Baseline Questionnaire
Pretest Followup
None, None
Pretest Followup Questionnaire
,
Supplementary Quality of Life Questions
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
3,814
3,814
0
0
0
0
Annual Time Burden (Hours)
718
718
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$482,067
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Maryam Daneshvar 4046394604
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
12/10/2008
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